Out Front Ideas With Kimberly and Mark – Workers Compensation Telemedicine – One To Check Out For Sure

Real Workers Compensation telemedicine has now arrived compared to even just three years ago. Some websites featured telemedicine as a new avenue for treating remote non-serious injuries.

Public Use License – Wikimedia Commons

I was extremely skeptical of this platform initially. I then came across a few telemedicine booths at the 2016 NWCDC Conference in Las Vegas. However, the providers seemed just to be getting a foothold into what seemed to be an enormous marketing segment.

Out Front Ideas will host a workers compensation telemedicine webinar on June 12th at 11 am Central Time. It is Freebies, as is all of their webinars.

The three questions that I always hear from adjusters/risk managers on telemedicine are:

Can serious injury follow up work on a telemedicine platform?

Will this make malingerers stay off from work longer than an in-person appointment?

What is the cost?

Tune in June 12th to have those and other questions answered with two of my favorite Workers Compensation people. From their website:

The deployment of telemedicine solutions is growing in the employer benefit space, offering more opportunities for employees to engage in their health than ever before.

Join us for a complimentary Out Front Ideas with Kimberly and Mark webinar where a panel of experts will explore how employers are using telemedicine to manage chronic diseases, enhance wellbeing, improve health literacy and provide virtual care.

You will learn:

How telemedicine has become an important component to delivering a well-rounded health and productivity solution.

Several examples of successful employer applications within the workplace.

How to approach implementation of telemedicine into your existing program.

Potential costs and savings associated with use.

The future outlook for telemedicine.

Speakers include:

Ann Schnure, Vice President, Telemedicine, Concentra

Susan Emerson, General Manager, Delta Airlines

You get to hear from a major airline on handling worker comp claims by telemedicine.

The Insurance Academy that is part of the Insurance Journal invited me to do a free-form presentation tomorrow at 1:30 PM Eastern.

I decided to do one on how sub-contractors and contractors have been shut out of contracts for a .01 too high-risk factor.

Yes, .01 can lose companies millions and turn the rating bureaus into quasi-credit bureaus. The Insurance Academy presentation is located here if you wish to sign up.

How did I come up with this topic? We receive phone calls and emails on this very topic weekly, if not daily. Bidding on contracts changed a few years ago when certain new contract clauses caused quite a stir.

The webinar description:

The newest trend in Workers’ Compensation works against any company or organization with an Experience Modification Factor (E-Mod or X-Mod) over 1.0. Public sector RFP requirements have been designating “no bidding” on contracts if the E-Mod is over 1.0 for years.

The trend has now spread to private employers on bids and subcontracts. This is currently a hot topic among agents and Risk Managers.

In this webinar you will be able to see how an E-Mod:

Can increase to an unacceptable level with just a few dollars of increased claims.

Affects Contractor coinsurance requirements

Decreases with a targeted Loss Run review

Can be “negotiated”

The webinar will also cover the E-Mod cycle and how to plan for the future E-Mod levels. Alternatives to the regular insurance marketplace will also be covered in detail.

The shocking part of the development is that agents, Risk Managers, and small business owners may not realize the Workers Compensation rating situation they are in until their bid is rejected by a governmental entity or prime contractor. We have many clients that have come on board with us just to stave off losing up to 80% of their business overnight.

Even if you cannot make the webinar, if you register, you can receive a recording of it to listen to later. It is free to members of the Insurance Academy.

Reevaluating Pain Management – Webinar On Post-Opioid Treatment

– Pain management is now moving to a post-opioid era. So many articles have been written that rethinks the epidemic. Recently, a study was published in the JAMA (Journal of the American Medical Association) where NSAIDS and Acetaminophen were more effective for pain reduction.

Public Use License – Wikimedia

OK, so what happens now? Do we take NSAIDS or Acetaminophen for pain?

A large portion of the WCRI Conference last week addressed opioids. One major finding was that opioids extended the length of the Total Temporary Disability period. The workers comp community has heavily covered opioid abuse over the last 3-5 years.

Out Front Ideas With Kimberly George (Sedgwick) and Mark Walls (Safety National) is sponsoring a webinar April 10th at 11:30 AM CST.

According to OutFront:

The workers’ compensation community has been working for years to address the appropriate use of opioid medications for pain. Now that we are moving away from opioids as the first choice of treatment, what are the alternatives for treating chronic pain? Pain is very subjective, and every individual responds to it differently, so there is no “one-size-fits-all” solution.

Significant Experience Rating Plan changes are coming in 2019. Learn more about the changes by attending our WCIRB Mod Talks webinar series. Each 30-minute webinar starts with a brief presentation followed by Q&A session. Space is limited, register now at the links below to reserve your spot:

#1: How the New Plan Will WorkThursday, February 15, 2018, 10:00 AM PT
An in-depth overview of the 2019 Experience Rating Plan changes.Register Now>

#2: Treatment of Exception ClaimsThursday, April 26, 2018, 10:00 AM PT
Learn how exception claims will be treated in the new Experience Rating Plan.Register Now>

The WCIRB has always been very helpful and gracious whenever I attended webinars or had any questions. They always try to help as much as possible in most of my dealings with them.

Make sure to ask any questions that you may have at the end of the webinar.

The WCIRB is usually very good about recording their webinars for later listening. However, there is no guarantee they will record the one today.

As always, I will keep you updated on the California WCIRB X-Mod changes as they occur in 2018.

Binge listening to Free Workers Comp Webinars may not be on everyone’s list of things to do for the new year. If you are involved with Workers Comp in any way, shape, or form – you should take advantage of a complete day – you will need to sleep sometime- of the free workers comp webinars.

Wikimedia License Anandajoti Bhikkhu

I think Mark Walls and Kimberly George (Safety National and Sedgwick, respectively) only ask for basic contact info. Most webinars (no offense to those) charge $99. So, that is approximately $2,400 worth of webinars. The webinars cover from 2015 to date.

Most readers like to stay on our page and do not like to go off onto another website, so below is the complete offerings from their webinar page.

I have listened in on approximately 1/2 of them due to time constraints. The 12 hours I spent was well worth it. No, Kimberly and Mark (two great people from the Workers Comp Community) have not asked or paid me to recommend their webinars.

Think of it as a Holiday Gift especially if those webinars help you with a presentation or other type of project. Remember to credit OutFront Ideas if you decide to use any of the material from their Free Workers Comp Webinars. One of my New Year’s resolution is to listen to some of them over the coming weeks. Maybe it should be one of your resolutions.

It is big news for the workers’ compensation and healthcare community when a rehabilitation facility that is considered the best in the world decides to reinvent itself. In March, the world-renowned Rehab Institute of Chicago opened a new, state-of-the-art facility and rebranded themselves as the Shirley Ryan AbilityLab. Out Front Ideas with Kimberly and Mark was invited to go behind the scenes for an immersion experience and produced a professional documentary to share our enlightening visit.

View “Live from the Shirley Ryan AbilityLab” on demand to:

Go behind the scenes and learn first-hand what it is like to be a patient at this facility.

Hear perspectives of guests who participated in the immersion experience.

Learn about the facility’s vision and their viewpoints on the future of rehabilitative medicine.

Hear leadership discuss their most important measure of success and new measures developed to determine results.

Learn how the relationship between researchers and clinicians helps to improve patient outcomes.

June 18 webinar “How Will OSHA Changes Impact Your Workers’ Compensation Program,” with panelists Mark Sullivan, Aon Hewitt and Melissa Bailey, Ogletree Deakins. Please note that we experienced technical difficulties at the beginning of the recording that prevented us from recording the introduction. The recording starts on the first topic slide, so no content was lost.

April 24 LIVE broadcast from RIMS 2015 “The evolution of the workers’ compensation industry.” Watch the video here.

Workers Comp Medical Networks Save Money vs. Not Having Them – Three Sources Agree On One Point

Most workers comp medical networks cause many headaches when established upfront. The costs in time, effort, and funds almost always generates even more of a benefit. Many years ago, I wrote the Six Keys To Saving on Workers Comp. Those have not changed over the years – 10 to be exact.

One of those keys points to medical – especially physician networks – as a large cost saver. NCCI confirmed that key at their Annual Issue Symposium. The savings may not look that significant in their study, however, 3% of medical costs totals a large amount when examining medical outlays.

The recent WCRI study on medical networks concerned me. I made the mistake of reading the reports from various sources without reading the study itself. I remained quiet for weeks until the study confirmed what NCCI and I had inferred on workers comp medical networks.

Unless I am mistaken, the one “wobbling” variable is the employer that has a network in place, but allows the employee to make the initial treatment choice. Then the costs would be similar.

My two studies in North Carolina and our current list of clients with medical networks show a huge reduction in costs after installing a medical network and then using it.

As I have assisted employers with installing medical choice networks in states that allow the employer to make the medical choice, their Workers Compcosts have reduced by 75% on the average.

I did not keep the data that I covered in my own studies. I was performing informal studies as files were audited for public employers.

WCRI webinar on June 15th on Physician Choice

Should the choice of provider in workers’ compensation cases be left to workers or employers? The Workers Compensation Research Institute (WCRI) will share its latest research informing this question during a 45-minute webinar on Wednesday, June 14, 2017, at 2 p.m. ET (1 p.m. CT, 12 noon MT, and 11 a.m. PT). The webinar will be hosted by Dr. Bogdan Savych, a public policy analyst at WCRI.

Dr. Savych led the groundbreaking study on how injured employees fared post-injury by actually interviewing the employees. The study is among my favorites overall and my preferred study from WCRI.

Attendance is limited to 100 people and all attendees receive a free copy of the slides. Click here to register.

WCIRB Mod Talk Sessions for 2016

The WCIRB Mod Talk webinars are very informative and enlightening on the changes that are occurring with the new Variable Split points.

The WCIRB – Workers Compensation Insurance Rating Bureau- is the work comp rating bureau for California employers. They have always been (except one person) very nice, professional, and hospitable to me in all my dealings with the bureau.

The variable split points are now centered on Expected Loss Ratios. You can find the slides and webinar recordings for the WCRIB Mod Talk webinars here.

I had decided to listen to the Q&A part of the webinars very closely. As with most rating bureau webinars, the listener questions is where the “rubber meets the road.”

Please remember these are my individual notes, so I could have missed something or accidentally over-embellished a point. I listened to all the sessions yesterday.

The recordings were listened to once. I wanted the feel of the notes to be more “live”. No second pass was made at the recordings.

Questions and Answers

Please note these are raw notes from the WCIRB Mod Talk Q&A sessions at the end of each webinar. The WCIRB Mod Talk presenters performed well overall.

Employer Size

WCIRB sees company as small 10,000 to 15,000 premium Medium 50,000

Extremely small company is not subject to rating plan less than $5,000 premium

Rating Calculator

New Rating Calculator in June will not handle complex situations such as subrogation

NCCI has pre-populated, not WCIRB

2015 Change- Limit to .25 swing due to one claim for companies with just one big l loss – still in effect

Simplify plan in future

Current formula is complex 8 variable

WCIRB not abandoning the 8 variable measure

Eliminate credibility in future?

Dramatic simplification in future

First Aid Issue

WCIRB looking at First Aid issue

Avoidance of reporting small claims

New Mod calculation – Increase potential to not report claims?

Why no phase in period (like NCCI)?

Most employers would see .02 change at most

Will handle all incoming questions by emails….. <<<WCIRB has laways answered every email or phone call from me.

Premium neutral plan? Yes.

April webinar –

Uncooperative employers for audits will have claims exposure calculated into the X-Mod without the offsetting payroll figures<<<ouch!!!

How does unaudited payroll affect the split point threshold – unaudited payroll

Will the 25% limit on one claim from a loss free rating still exist? 25% limit will not apply if uncooperative employer

If an employer is uncooperative for two years, how would that work? Only one year of payroll would be used out of three years

Insolvent insurers – What happens if there is no unit statistical report provided by insurer? No new changes

Time period used in X-Mod calculations- can smaller employers use longer experience periods to calculate X-Mod (5-8 Years?) Did not really make sense to do that

May webinar –

Simplified formula not in force on 2017 , possibly 2019 if no fine tuning needed to program

Are all class codes included not just governing class code? All class codes

Excess loss presently handled? Confusing answer ….

July Webinar

Experience is a zero sum game- most response to new variable split points have been positive

There will be some winners and losers in the new system

The X-Mod estimator may or may not be 100% accurate if the data input is off

99% accuracy on the X-Mod estimator

The estimator requires group of claims of 5,000 or greater be broken into individual claims, best to list all claims individually

Questions came in that the estimator was not working correctly(?)

September Webinar was postponed.

The WCIRB Mod talks are easily accessible online. If you have any CA WC companies or interests, it may be worth the three hours to listen to the webinars. If not, the slides are there as a quick-look at the upcoming changes.

The title of the webinar is “Make the Work Comp Adjuster Your Friend: Getting the Best for Your Client.” The sign up page is here.

The topic is one that few persons or companies outside of the Workers Comp claims environments have analyzed or discussed as a way to build a team. Building a good employer/adjuster relationship will be the main takeaway.

According to James Moore –

“The WC insurance adjuster sets the reserves on files which eventually result in an insured’s Experience Mod (E-Mod or X-Mod). The Total Incurred values feed directly into the E-Mod formula. For self insureds, the critical budgeting phase for future WC expenditures is based on the reserves. A positive familiarity with the insured does have an effect on the reserves.

One thing to remember is that adjusters usually communicate more with the insured employers than any other party. The adjusters can be an intricate part of the team that provides a satisfactory experience for the insureds. If an employer is unhappy with their adjusters, an agent or any other insurance personnel may not be able to overcome this dissatisfaction. The adjuster/insured relationship heavily affects the insurance renewal process.”

The webinar will cover (in detail) the best way to “team up” with the insurance carriers’ claims adjusting staff including the:

Adjuster’s daily tasks and priorities

Art of reserving a file

Quickest way to team up with the adjuster

Best time and how to discuss reserves with the adjuster

There are six areas that can make or break the adjuster/insured relationship. Those areas will be covered to help facilitate this important relationship.

Webinar Tomorrow on ASC’s in 23 states

WCRI (Workers Compensation Research Institute) has a great and reasonably-priced webinar tomorrow at 2PM Eastern. WCRI is a Workers Comp data wonk research organization that produces unbiased non-rating bureau research.

The ASC stands for Ambulatory Surgery Center. At one time in the past, they were a great alternative to hospital-based surgery centers. State laws and profit margins have changed ASC’s over the years. ASC’s are still a viable option, but not in all states

From WCRI –As you may know, the webinar discusses the following studies:

Payments to Ambulatory Surgery Centers: this study helps policymakers and system stakeholders better understand the ASC payments for common surgeries in their state, how they compare with other states, and the role of different types of fee schedules.

Both studies include 23 states, which represent over two-thirds of the workers’ compensation benefits paid in the United States. These states are Arizona, California, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

Questions addressed:

Are surgeries performed in ASCs less costly than hospital outpatient surgeries?

What impact do fee schedules have on payments for surgeries performed at ASCs?

What states have the highest and lowest ASC payments for surgeries and why?

Webinars are $39 for WCRI members; $79 for non-members; and no charge for members of the press, legislators as well as their staff, and state public officials who make policy decisions impacting their state’s workers’ compensation system. All attendees receive a free copy of the slides.

WCRI Webinar A Great Reference Tool

Last week, the Workers Compensation Research Institute (WCRI) held what was a surprisingly good webinar on the results of their multi-state phone surveys of Workers

Compensation injured workers three years after their accident date.A prior blog article was posted on the webinar on the Cutcompcosts.com blog here.The word surprisingly was used as most WC webinars usually result in me switching to something else before the webinar is finished. That may be due to a bout of ADHD. The whole webinar was very interesting.Kudos are given to WCRI for actually running over on time, which can be costly, to answer a multitude of questions. That rarely happens nowadays.

The one statistical difference between this study and most of the studies by the rating bureaus or other organizations is that WCRI actually obtained the data one injured worker at a time and did not wait three years for the predictors to show up in old data.

Upcoming WCRI Teleconference

The upcoming WCRI teleconference on predicting WC outcomes.WCRI (Workers Compensation Research Institute) has scheduled a one-hour webinar on Thursday, October 16, 2014 at 2 p.m. ET (1 p.m. CT, 12 p.m. MT, and 11 a.m. PT) to discuss this new research. The cost of the seminar is only $79 for non-members.

This is a rare opportunity to see statistics from the “other side of the table.” as the data was compiled directly from the injured workers. I will be listening on this one as we have many clients in the states WCRI will be covering on the 16th. Some of the areas that WCRI will cover are:

Why was trust one of the more important predictors of worker outcomes?

What role did comorbid medical conditions have on an injured workers ability to return to work?

How do things like severity and type of injury as well as other characteristics (age, sex, education, language, marital status and job history) impact worker outcomes?

Do labor market conditions, such as local urbanization and the unemployment rate, have an impact?

WCRI is the only research provider of Workers Comp that actually performs studies by directly contacting the injured employees. The studies are based on telephone interviews with 3,200 injured workers across eight states:

Indiana

Massachusetts

Michigan

Minnesota

North Carolina

Pennsylvania

Virginia

Wisconsin.

The studies interviewed workers who suffered a work place injury in 2010 and spent at least 7 days away from work. The surveys were conducted during February through June 2013—on average, about three years after these workers sustained their injuries.I attended WCRI’s March 2013 annual conference where the speakers covered the same subject. The presentation was very interesting. For more information or to register go to the teleconference page.

Thumbs Up – California SB 863 Webinar

According to sponsors, the SB 863 Webinar turnout was massive. That is to be expected with such a confusing subject. The reforms were extensive. They presenters had to cover a large amount of info in 75 minutes.

Insurers were paying over 35% of the claims dollars to administer the claims. That is a surprisingly high figure.

SB 863 goals were the same as any reform, reduce costs and increase efficiency especially medical care for injured workers. Reducing litigation costs was also an expected goal.

SB 863 wanted to strengthen Medical Provider Networks (MPN’s) also known as Workers Comp PPO’s. Limiting out-of-network treatment was a goal. I think that was a great idea. I have written a large numbers of posts on medical control.

There must now be an assistance staff that helps the employee find proper in-network care. That was a good idea.

Independent Medical Review (IMR) will be established and will have all jurisdiction over an employee dispute about medical treatment Division of Workers Compensation (DWC) will contract this duty to an approved third party reviewer.

Utilization Review (UR) will fit in the IMR process. Employee initiates IMR process by filing a form with the DWC within 30 days of treatment. My response is great, another form. I am not sure if adding another process on top of the other processes is that efficient. As the presenters pointed out, it is a work in process. The treating physician can also initiate the IMR process. I wonder if that could be abused in some way.

The handling of medical bill payments was also a big issue. The doctors have to provide better info such as the applicable treatment notes. Only the original treating doctor can approve any other services. This is basically what already happens in states that allow medical control.

The carrier/TPA must pay medical bills within 45 days. The Explanation of Review must have all the info for medical provider to understand the payment received from the payer.

If there is Independent Bill Review (IBR) over charges, the medical provider must pay the DWC a fee if there are no additional charges. If the carrier or TPA owes an additional amount, they will pay the DWC a fee. This functions as an incentive to pay the bill properly in the first place.

(c) 123rf.com

IBR will cut down the length of time on medical bills disputes and not allow them to linger for years. If the provider did not use the IBR process, there is no lien applicable. This is a good development for the CA WC system.

Medical legal reforms required that chiropractors pass the same qualified medical examiner (QME) tests as other medical providers. QME’s are limited to a maximum of 10 locations.

The reforms limited spine surgeons receiving a rebate for a medical implantable device from the manufacturer and then receiving full payment by the carrier/TPA.

Fee schedules will be now based on Medicaid/Medicare fee schedules. This is the same as most states have been doing for many years.

Permanent disability (PD) payments are going to increase. The law that allowed this was legislated in 2009, but it was never enacted or enforced.

As with the SB 899 reforms, expect a large amount of litigation on SB 863 along with legislative attacks to dilute the reforms.

The presenters said the advisory rates recommended by the WCIRB (CA Rating Bureau) will be unchanged with no increases. However, the word on the street is that some of the major carriers are asking for 21+% increases. As I pointed out a few weeks ago, the advisory rates are nefarious figures if they carriers deviate heavily from the advisory rates.

Overall, heavy kudos should be given to the presenters and their organizations. They did a good job in presenting a concise overview of a very large reform.Even if you are not a CA employer, some of these reforms and concerns will be coming to states in which you operate your business.

Email Subscription

Email Subscription

Search this website:

About Me

James J Moore
Raleigh, NC, United States

James founded a Workers' Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L's mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers' Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James's educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.